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Characteristics associated with occurrence of stroke in patients with infective endocarditis - a retrospective cohort
H Schuermann1,2,3, R von Rennenberg4,5, C Riegler4,5
1Klinik und Hochschulambulanz für Neurologie, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Hindenburgdamm 30, 12203, Berlin, Germany. Hannah.schuermann@charite.de.
Insights
Infective endocarditis (IE) patients with stroke often have systemic complications, particularly from dental infections. Congenital heart disease may reduce stroke risk in IE patients.
Area of Science:
- Cardiology
- Neurology
- Infectious Diseases
Background:
- Infective endocarditis (IE) is a serious condition with a high mortality rate, often complicated by stroke.
- Understanding the differences between IE patients with and without stroke is crucial for improving patient outcomes and management strategies.
Purpose of the Study:
- To identify clinical and microbiological factors associated with stroke occurrence in patients with infective endocarditis.
- To compare characteristics of IE patients who experienced stroke versus those who did not.
Main Methods:
- Retrospective analysis of medical records from 353 IE patients treated between 2019 and 2021 at three German academic hospitals.
- Multivariable logistic regression was employed to determine independent predictors of stroke in IE patients.
Main Results:
- Stroke occurred in 27.2% of IE patients.
- Independent risk factors for stroke included extracerebral arterial embolism, acute liver failure, dental infections, and left-sided IE.
- Congenital heart disease and isolation of atypical pathogens were associated with a lower incidence of stroke.
Conclusions:
- Stroke in IE is linked to systemic complications affecting other organs and highlights the importance of dental health.
- The reduced stroke incidence in patients with congenital heart disease may be attributed to increased awareness and prophylactic measures.
Background:
Stroke is a severe complication of infective endocarditis (IE), associated with high rates of mortality. Data on how IE patients with and without stroke differ may help to improve understanding contributing mechanisms.
Methods:
All patients treated for IE between 2019 and 2021 with and without associated stroke were identified from the medical records of three academic tertiary care hospitals in Germany, all part of Charité - Universitätsmedizin Berlin, Germany. Multivariable logistic regression analyses were performed to identify variables associated with the occurrence of stroke.
Results:
The study population consisted of 353 patients diagnosed with IE. Concomitant stroke occurred in 96/353 (27.2%) patients. Acute stroke was independently associated with co-occurring extracerebral arterial embolism [adjusted Odds ratio (aOR = 2.52; 95% confidence interval (CI) 1.35-4.71)], acute liver failure (aOR = 2.62; 95% CI 1.06-6.50), dental focus of infection (aOR = 3.14; 95% CI 1.21-8.12) and left-sided IE (aOR = 28.26; 95% CI 3.59-222.19). Stroke was found less often in IE patients with congenital heart disease (aOR = 0.20; 95% CI 0.04-0.99) and atypical pathogens isolated from blood culture (aOR = 0.31; 95% CI 0.14-0.72).
Conclusions:
Stroke is more likely to occur in individuals with systemic complications affecting other organs, too. Special attention should be addressed to dental status. The low incidence of stroke in patients with congenital heart disease may reflect awareness and prophylactic measures.
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